Liu Che-Wei, Lenke Lawrence G, Tan Lee A, Oh Taemin, Chao Kou-Hua, Lin Shi-Ding, Pan Ru-Yu
Department of Orthopedics, Cathay General Hospital, Taipei City, Taiwan.
The Daniel and Jane Och Spine Hospital, Department of Orthopedics, Columbia University Medical Center, New York, NY, USA.
Neurospine. 2020 Dec;17(4):902-909. doi: 10.14245/ns.2040234.117. Epub 2020 Dec 31.
To examine existing literature and pool the data to determine the relative odds ratio of "adding-on" (AO) based on various reported criteria for lower instrumented vertebra (LIV) selection in Lenke type 1A and 2A curves.
Using electronic databases, studies reporting on AO and LIV selection in Lenke type 1A and 2A curves were identified. Studies were excluded if they failed to meet the following criteria: ≥ 30 patients, Lenke type 1A or 2A curves, thoracic-only fusions, and inclusion of outcome differences in AO and non-AO groups. Review articles, letters, and case reports were excluded.
Six studies were identified reporting on 732 patients with either Lenke type 1A or 2A curves treated with thoracic-only fusions. Five different landmarks were used for LIV selection in these studies including the stable vertebra (SV) -1, end vertebra (EV) +1, neutral vertebra (NV), touched vertebra (TV), and substantially touched vertebra (STV) versus nonsubstantially touched vertebra (nSTV) +1. The pooled odds ratios of AO for choosing LIV at levels above the afore landmarks (i.e. , ending the construct "short") versus at the landmarks were 2.59 (SV-1), 2.43 (EV+1), 3.05 (NV), 3.40 (TV), and 4.52 (STV/nSTV+1), all at 95% confidence interval.
Five landmarks shared a similar characteristic in that the incidence of AO was significantly higher if the LIV was proximal to the chosen landmark. In addition, choosing STV/(nSTV+1) as the LIV have the lowest absolute risk of AO and the greatest risk reduction. If additional levels were fused (i.e. , LIV distal to the landmark), there was no statistically significant benefit in further reducing the risk of AO. Selection of the optimal LIV is a complex issue and spine surgeons must balance the risk of AO with the need for motion preservation in young patients.
查阅现有文献并汇总数据，以确定基于各种报告标准在Lenke 1A和2A型脊柱侧弯中选择下固定椎（LIV）时“附加融合”（AO）的相对比值比。
利用电子数据库，检索关于Lenke 1A和2A型脊柱侧弯中AO及LIV选择的研究。若研究不符合以下标准则被排除：患者≥30例、Lenke 1A或2A型脊柱侧弯、仅胸段融合，以及纳入AO组和非AO组的结局差异。综述文章、信函和病例报告均被排除。
共识别出6项研究，报道了732例接受仅胸段融合治疗的Lenke 1A或2A型脊柱侧弯患者。这些研究中使用了5种不同的标志点进行LIV选择，包括稳定椎（SV）-1、终椎（EV）+1、中立椎（NV）、触及椎（TV），以及实质触及椎（STV）与非实质触及椎（nSTV）+1。与在这些标志点处选择LIV相比，在上述标志点上方水平选择LIV（即缩短内固定节段）时AO的合并比值比分别为2.59（SV-1）、2.43（EV+1）、3.05（NV）、3.40（TV）和4.52（STV/nSTV+1），均为95%置信区间。
5个标志点具有相似的特征，即如果LIV靠近所选标志点，AO的发生率显著更高。此外，选择STV/（nSTV+1）作为LIV时AO的绝对风险最低，风险降低幅度最大。如果融合更多节段（即LIV在标志点远端），在进一步降低AO风险方面没有统计学上的显著益处。选择最佳LIV是一个复杂的问题，脊柱外科医生必须在AO风险与年轻患者保留运动功能的需求之间取得平衡。
